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Susan Johnston is a 60-year-old woman with an elevated BMI.

She has a history of

dyslipidemia and hypertension. She presents with a three-month history of intermittent chest pain

with SOB on exertion that is relieved on its own. She also has a family history of cardiac disease

and type 2 diabetes. She does not smoke and drinks rarely.

Onset: Can you describe when these symptoms started? The patient reported onset of symptoms

three months ago.

Location: Where is the pain located? Patient states it is right in the middle of the chest.

Duration: How long does the chest pain last? Patient states it goes away in 2-3 minutes.

Characteristics: Can you describe the pain? The patient states a burning pain and sometimes a

tingling sensation. She denies diaphoresis, nausea, vomiting, dyspepsia or belching, or

palpitations

Aggravating Factors: Aggravating factors reported by the patient are when she is active, like

climbing the stairs. The patient also states that chest pain sometimes occurs at rest.

Relieving Factors: Pain is relieved in 2-3 minutes.

Treatment: Have you taken anything to relieve the pain? Patient states she rests, and at one time

a glass of cold water relieved the symptoms.

Severity: On a scale of 1-10 how would you rate the severity of your pain? Do you feel the pain

spread to your neck, arm, or jaw? Does the chest pain change in severity? Mrs. Johnston’s states

pain is a six out of 10. Pain does not change with body positioning, is not radiating, and severity

does not vary.


Physical Examination

A physical examination would include vital signs, height, weight, auscultation of the

heart and lungs, as well as palpation of Mrs. Johnston’s peripheral pulses to see if they are

diminished. Patients with angina may present with hypertension, an S3 or S4 heart sounds, or a

heart murmur. A physical examination should also focus on abnormal findings suggesting non-

ischemic causes of angina, such as valvular aortic stenosis, cardiomyopathy, and pulmonary

hypertension (Alaeddini, 2017). According to the American Heart Association, recommended

blood tests include cardiac enzymes, c-reactive protein, fibrinogen, homocysteine, lipoproteins,

triglycerides, brain natriuretic peptide (BNP) and prothrombin (2017). I would also order a CBC

to test for anemia and a CMP to test for electrolytes. The AHA also recommends an EKG to be

done and a stress test.

Plan of Care, patient education, and follow-up

The plan of care for Mrs. Johnston would first be to educate her on lifestyle changes.

According to the AHA, Mrs. Johnson’s plan of care would be for her to start exercising regularly

and start eating a healthy diet to lower her BMI and cholesterol to help reduce her risk of cardiac

disease (2017). To manage Mrs. Johnston’s hypertension, she will start using anti-hypertensive

medications, like a beta-blocker or a calcium-channel blocker. She will continue taking her

lisinopril, hydrochlorothiazide, and aspirin. Mrs. Johnston’s stress test was positive, and a

coronary angiogram was ordered for a cardiac catheterization. Patient education and follow-up

would be to check her vital signs to see if her blood pressure has decreased, assess her lifestyle
changes, and educate Mrs. Johnston to continue taking her medications and evaluate for side

effects.

References

American Heart Association (2017). Angina (Chest Pain). Dallas, TX

Alaeddini, J. (2017). Angina Pectoris Clinical Presentation Retrieved from


https://emedicine.medscape.com/article/150215-clinical#b2
Great post Kami, I agree with your case study. I would also like to add that nitroglycerin

is used to treat stable angina. According to the American Heart Association, I would provide

patient education on this medication including the purpose, dose, frequency and side effects

(2018). I would also educate on the symptoms of a myocardial infarction and how to seek help if

one occurs. The AHA states that if chest discomfort lasts more than 2-3 minutes, the patient

should rest and stop all activity. If pain persists, to take nitroglycerin. If the pain is not relieved

within 5 minutes, another nitroglycerin can be taken, as well as a second and third dose at 5-

minute intervals. If pain lasts more than 15-20 minutes, call 911 and go to the nearest hospital

(2018).

References

American Heart Association (2018). ACC/AHA Guidelines for the Management of Patients with

Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive

Summary and Recommendations. Dallas, TX